Dependence MCQs With Answer

Dependence MCQs With Answer for B.Pharm students: Understanding drug dependence—its pharmacology, mechanisms, clinical features, and management—is essential for safe therapeutics. This set of focused, evidence-based MCQs covers physical and psychological dependence, tolerance, withdrawal syndromes, receptor adaptations (GABA, NMDA, mu-opioid, nicotinic), diagnostic frameworks, scoring tools (CIWA-Ar, COWS), and pharmacotherapies (methadone, buprenorphine, naloxone, naltrexone, disulfiram, acamprosate, varenicline, bupropion). Questions emphasize pharmaco-therapeutic principles, detox strategies, harm reduction, drug interactions and factors influencing abuse potential. Designed to deepen your clinical reasoning, these practice questions help B.Pharm students prepare for exams and patient-care decisions. Now let’s test your knowledge with 30 MCQs on this topic.

Q1. Which statement best defines physical dependence?

• Physiological adaptation producing withdrawal symptoms on abrupt cessation
• Compulsive drug-seeking despite harm
• Legal requirement for prescription monitoring
• Increased pleasure from repeated drug use

Correct Answer: Physiological adaptation producing withdrawal symptoms on abrupt cessation

Q2. Psychological dependence is primarily characterized by which feature?

• Development of life-threatening withdrawal symptoms
• Compulsive craving and drug-seeking behavior
• Immediate organ toxicity from the drug
• Only pharmacokinetic tolerance

Correct Answer: Compulsive craving and drug-seeking behavior

Q3. What does pharmacological tolerance refer to?

• Reduced drug effect after repeated administration requiring higher doses
• Development of withdrawal symptoms on cessation
• Increased adverse effects with continued use
• Permanent immunity to drug actions

Correct Answer: Reduced drug effect after repeated administration requiring higher doses

Q4. Which cellular mechanism commonly contributes to opioid tolerance?

• Mu-opioid receptor desensitization and downregulation
• Upregulation of dopamine D2 receptors
• Inhibition of CYP3A4 metabolism
• Increased renal clearance of opioids

Correct Answer: Mu-opioid receptor desensitization and downregulation

Q5. Typical features of opioid withdrawal include:

• Lacrimation, yawning, piloerection, mydriasis and rhinorrhea
• Grand mal seizures and hyperthermia
• Profound euphoria and hyperphagia
• Severe hallucinations and visual disturbances

Correct Answer: Lacrimation, yawning, piloerection, mydriasis and rhinorrhea

Q6. Which complication of alcohol withdrawal is life-threatening and requires urgent management?

• Delirium tremens
• Mild tremor and insomnia
• Increased appetite
• Pinpoint pupils

Correct Answer: Delirium tremens

Q7. First-line pharmacotherapy for severe alcohol withdrawal is:

• Benzodiazepines
• Naltrexone
• Disulfiram
• Acamprosate

Correct Answer: Benzodiazepines

Q8. Which medication is commonly used for opioid maintenance therapy in dependence treatment?

• Methadone
• Flumazenil
• Disulfiram
• Acamprosate

Correct Answer: Methadone

Q9. Which agent is a partial opioid agonist used to treat opioid dependence?

• Buprenorphine
• Naloxone
• Morphine
• Naltrexone

Correct Answer: Buprenorphine

Q10. Which drug is the opioid antagonist of choice for reversing acute opioid overdose?

• Naloxone
• Naltrexone
• Methadone
• Buprenorphine

Correct Answer: Naloxone

Q11. Naltrexone is primarily used in dependence management for which purpose?

• Maintenance therapy to prevent relapse
• Immediate reversal of opioid overdose
• Alleviating acute benzodiazepine withdrawal
• Enhancing alcohol metabolism via ADH induction

Correct Answer: Maintenance therapy to prevent relapse

Q12. Disulfiram reduces alcohol consumption by which mechanism?

• Inhibition of aldehyde dehydrogenase leading to acetaldehyde accumulation
• Blocking histamine H1 receptors causing aversion
• Enhancing GABAergic transmission to reduce craving
• Competitive antagonism at NMDA receptors

Correct Answer: Inhibition of aldehyde dehydrogenase leading to acetaldehyde accumulation

Q13. Acamprosate helps maintain abstinence in alcohol dependence primarily by:

• Modulating glutamatergic neurotransmission and restoring GABA-glutamate balance
• Inhibiting aldehyde dehydrogenase
• Acting as a mu-opioid receptor agonist
• Directly blocking dopamine reuptake

Correct Answer: Modulating glutamatergic neurotransmission and restoring GABA-glutamate balance

Q14. The CIWA-Ar scale is used to:

• Assess severity of alcohol withdrawal
• Detect opioid intoxication
• Measure nicotine dependence
• Assess benzodiazepine blood levels

Correct Answer: Assess severity of alcohol withdrawal

Q15. The COWS score is a clinical tool for assessing:

• Opiate withdrawal severity
• Alcohol withdrawal severity
• Benzodiazepine intoxication
• Nicotine withdrawal symptoms

Correct Answer: Opiate withdrawal severity

Q16. Which pair demonstrates cross-tolerance due to similar CNS depressant actions?

• Benzodiazepines and alcohol
• Methadone and naloxone
• Nicotine and bupropion
• Disulfiram and acamprosate

Correct Answer: Benzodiazepines and alcohol

Q17. Chronic benzodiazepine use leads to dependence mainly through:

• GABA-A receptor downregulation and neuroadaptation
• Increased monoamine oxidase activity
• Permanent increase in glutamate synthesis
• CYP2D6 induction causing faster metabolism

Correct Answer: GABA-A receptor downregulation and neuroadaptation

Q18. Which drug is used as a specific antagonist in benzodiazepine overdose?

• Flumazenil
• Naloxone
• Activated charcoal
• Naltrexone

Correct Answer: Flumazenil

Q19. First-line pharmacotherapy options to aid smoking cessation include:

• Nicotine replacement therapy (NRT)
• Disulfiram
• Methadone maintenance
• Flumazenil infusion

Correct Answer: Nicotine replacement therapy (NRT)

Q20. Varenicline aids smoking cessation by acting as a:

• Partial agonist at α4β2 nicotinic acetylcholine receptors
• Full agonist at mu-opioid receptors
• Monoamine oxidase inhibitor
• GABA-B receptor antagonist

Correct Answer: Partial agonist at α4β2 nicotinic acetylcholine receptors

Q21. Bupropion assists in nicotine dependence through its primary mechanism as:

• A norepinephrine-dopamine reuptake inhibitor
• An aldehyde dehydrogenase inhibitor
• A benzodiazepine receptor agonist
• An NMDA receptor antagonist

Correct Answer: A norepinephrine-dopamine reuptake inhibitor

Q22. Which pharmacokinetic property increases a drug’s abuse and dependence potential?

• Rapid onset of central effects
• Very slow oral absorption
• Extensive first-pass metabolism reducing bioavailability
• Long elimination half-life with steady plasma levels

Correct Answer: Rapid onset of central effects

Q23. Which change did DSM-5 introduce regarding the terminology for drug problems?

• Replaced “dependence” with “substance use disorder” spectrum
• Eliminated the concept of withdrawal entirely
• Defined dependence as always synonymous with tolerance
• Classified addiction as a personality disorder

Correct Answer: Replaced “dependence” with “substance use disorder” spectrum

Q24. Which statement correctly contrasts tolerance and dependence?

• Tolerance is reduced effect to a drug; dependence is manifested by withdrawal on cessation
• Tolerance always causes withdrawal symptoms
• Dependence is exclusively psychological without physical signs
• Tolerance is permanent after short-term use

Correct Answer: Tolerance is reduced effect to a drug; dependence is manifested by withdrawal on cessation

Q25. Withdrawal from which class is most associated with risk of seizures and delirium if unmanaged?

• Benzodiazepines and alcohol
• Narcotic analgesics
• Nicotine replacement therapies
• SSRIs

Correct Answer: Benzodiazepines and alcohol

Q26. The therapeutic use of methadone to suppress heroin withdrawal while preventing cravings is an example of:

• Cross-dependence
• Pharmacokinetic enhancement
• Antagonistic overdose treatment
• Behavioral aversion therapy

Correct Answer: Cross-dependence

Q27. Which pharmacokinetic factor lowers withdrawal severity and dependence risk?

• Long elimination half-life producing smoother plasma levels
• Rapid intravenous bolus administration
• High lipophilicity with swift brain penetration
• Short half-life requiring frequent dosing

Correct Answer: Long elimination half-life producing smoother plasma levels

Q28. Office-based management of opioid use disorder commonly uses which medication for outpatient induction and maintenance?

• Buprenorphine
• Flumazenil
• Acamprosate
• Naloxone infusion

Correct Answer: Buprenorphine

Q29. The mesolimbic reward pathway primarily involves increased release of which neurotransmitter in the nucleus accumbens?

• Dopamine
• GABA
• Acetylcholine
• Glutamate

Correct Answer: Dopamine

Q30. Which harm-reduction strategy is evidence-based for reducing infectious disease transmission among people who inject drugs?

• Needle and syringe exchange programs
• Mandatory inpatient detoxification only
• Complete prohibition of opioid substitution therapy
• Providing flumazenil in community centers

Correct Answer: Needle and syringe exchange programs

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com